Literally first result when I Google UK NHS cancer drug denied.
https://www.theguardian.com/society/...for-use-on-nhs


When I google UK NHS denies cancer treatment, past the migrant issues
https://www.pryers.co.uk/cancer-pati...cut-nhs-costs/
https://inews.co.uk/news/health/fath...m-therapy-nhs/

Every year (especially recently), NHS takes procedures and drugs that it deems ineffective (basically &/QALY too low) away. They aren't hiding this. It's explicit policy. There is an application for individualized services that looks a lot like asking for out of network specialist coverage.

Sure - the same thing would happen in literally any healthcare system in the world.

But what they don't do is send the patient a $100k bill in the middle of treatment for something the patient and doctor thought was covered.

What they don't do (and thankfully we don't either for the time being) is scour over that person's initial application, after happily taking their premiums for years, looking for any technicality to deny coverage.

What they don't do is force the patient to become a medical bill expert wading through Kafka-esque billing codes and endless bogus charges with no rhyme or reason to how much they cost.

You seem blissfully unaware of what actually happens to people who get expensively sick in this country.

https://www.statesman.com/article/20...NEWS/312029799

I guess this guy doesn't count as "secure middle class coverage" and sucks to be him? Get a real job you stupid hippy.

True

They just won't provide the service at all. US federal laws (case law and some requirements on tax-exempt status) essentially require hospitals to provide care. UK hospitals' duty to provide "emergency" care is much more limited.

Two responses:
1. NHS DOES look for reasons to deny. UK NHS in particular goes out of its way to check addresses and tries to punt expensive patients internally. You can just frame this as making sure the forms are filled out correctly and people are getting paid right amounts by the right parties. But when you're really sick, you think they are just nitpicking.
2. Insurance companies by and large almost always pay out if the treatment is explicitly covered. Yes they'll look for technicalities (wrong address) or what some would consider minor fraud (lying about smoking history to get a lower premium), but even then they typically still pay out.

Most end consumers never have to. The impact of medical billing complexity is vastly overstated is mostly a red herring for the real problem mentioned earlier where hospitals feel obligated to provide treatments without regard for patients' ability to pay.

I've clocked hundreds if not thousands of hours navigating insurance and hospital bills, mostly for recent Chinese immigrants that are disproportionately poor. I have also clocked significant hours pricing insurance plans.



There is no doubt UK NHS has significant advantages over the American system but the whole thing with not getting treatments denied is dumb. It spawns from the unholy union of two ideas/myths:
1. NHS/Canada like system can provide all the care we need.
2. Life should not have a dollar value
The combination of two ideas cause people to attribute all instances where care/coverage is denied to deficiencies in the US system.

The thing you really need to worry about in the American system, when you're super sick, is the various gaps in coverage due to the patchwork of regulatory codes and lack of coordination between different types of coverage.

People are obviously falling through cracks and it's obviously a problem with our system. I have never denied this. My point remains that most (not counting those covered by Medicaid/Medicare) Americans have pretty good employer-based coverage.

Let me put it this way, my problem with your post was it seemed to imply you won't get a letter denying cancer treatments in some kind of UK NHS style system.

Guys, we're never going to get it perfectly right! You think the UK NHS is so great? They have flaws! You think the Canadian system is so awesome, eh? They have flaws!

Since we can't get it perfect, we just have to stay with what we have... Once you liberals can convince us that you can get it perfectly right, then MAYBE we can see about changing. Until then, that stupid hippie should just get a real job or stop falling off his bike! It's unfair and it sucks, but the world ain't all sunshine and roses. Grow up, liberals!

That's not remotely close to what I said. What I said is NHS wouldn't fix the problem suzzer implied would be fixed, at least not to the extent the post seemed to imply.

Do people get charged $18k on top of already paying an insurance premium for falling off their bike in the UK?

Please share some UK horror stories that match the ones I posted. Everything you posted it bickering about effectiveness of various super expensive treatments. Obviously you're going to get that in any system. Unless your take is literally "every treatment should always be covered no matter the cost or effectiveness". Because that isn't going to happen anywhere.

What you don't get with the UK is people getting the rug yanked out from under them by an insurance company they've been paying beacoup $$ for years to - while they're in the fight of their life - and suddenly in hock $100k.

You don't get 70k bankruptcies a year in the UK over medical bills.

You don't get people only using the ER because they don't have health insurance.

It's just a much much better system.

Imagine ending Medicare (even with it's problems and needs for supplements) and replacing it with the FUBAR system we have now and even worse one we had before Obamacare. Try selling that to anyone over 65.

I have said repeatedly there are gaps in coverage in US so of course there are more horror stories. This still does not detract from the fact MOST middle class Americans are still covered by employers pretty well. This is as much a comment on political reality as a recognition that most Americans are in fact being served pretty well under status quo (especially if you bring Medicaid and Medicare into picture).

And I have also repeatedly explained UK hospitals don't have as many shock bills because they simply refuse to service you unless NHS authorizes or you prepay whereas US hospitals are obligated to provide services.

A lot of people will take bankruptcy over death... at least if they were offered the choice.

I have consistently said I support UHC and I think the easiest way to get there is a massive expansion of ACA or some Medicare Part C for all (depending on execution, this gets us close to German/Swiss systems). I have even outright said at some points that it may be socially desirable to basically create ignorance of therapies available (which NHS/Japan systems accomplish basically by having monopoly on payments so doctors don't bother offering procedures not on plan). (99.99% coverage (for major events) is just stupid standard. Nobody is that close to perfect, national systems included). The success rates of applications for major coverage at private insurers is higher than you think (depending on where you draw line, it's probably over 90% for big bills except for the absolutely most expensive stuff that national systems would curb too. Many procedures are semi-experimental in nature or some panel deemed to be only most suitable in very narrow circumstances... with those, success rates will be lower for sure but that's true with NHS too).

I only objected to your original post because the specific problem you mentioned (letter denying coverage) doesn't get fixed by any of the UHC systems people like to cite as successful systems. That post was particularly annoying to me because it perpetuates the myth of basically unlimited availability of treatments by implying a "denied" by US insurance treatment wouldn't be "denied" under national systems people like to cite. This kind of thing leads to bad diagnosis (the idea that almost everyone, except really rich people, is underinsured or uninsured in essence) and leads to bad treatments with more risk (both in terms of political and economic execution) than necessary

I have never made the claim US status quo overall is better than UK/Canadian system.

PS: Hospitals and insurers are also VERY uninterested in bankrupting you. Having worked with a lot of extremely low income and some middle income people and having seen debt collection rates in CA and other parts of the country, I can say with absolute 100% certainty that if you're conscientious and sincerely demonstrate financial hardship, MOST hospitals will work with you. They aren't interested in drawing blood from a stone. (alternative wording: hospitals don't care to pay lawyers to get money you don't have from you.)

According to this, from Wikipedia, less than half of Americans are covered by any employer health plan, let alone whatever you'd call "pretty secure middle class coverage".

A foundational principle of the US health system I'd say.

Well that sure should help folks sleep easily at night. Rest assured, my fellow Americans, hospitals and insurers don't want to ACTUALLY bankrupt you, they just want to take every dollar you have and every dollar you can possibly afford to pay them going forward without actually going bankrupt. See? That's not so bad now, is it?

While it's certainly true that the NHS looks at the cost effectiveness of various treatments this method has certain bartering benefits. For instance literally the first result when I google "Nivolumab NHS" (the drug in your article) is this:

https://www.nice.org.uk/news/article...e-new-cdf-deal

This highlights one of the benefits of a single payer system when it comes to setting prices for things.

Similarly a brief google search for Ibrutinib, the drug in your above article, leads me here:

NHS England removes restrictions that were preventing relapsed CLL patients from gaining access to ibrutinib

Most of those not covered by Medicaid and Medicare.

The fact that the UK has free health care is just so foreign in his Brain he can’t comprehend it’s really free

Ah yes. The good old I got mine so who cares

It doesn’t do anything for people’s mental health to have the stress of knowing you’re just a pink slip away from losing your coverage, or having to stay in a soul-sucking (or even abusive) job for health coverage. It also depresses wages because employers know you don’t have as much freedom of mobility as you should.

I don't disagree with any of that. Again, I objected to suzzer's post because it implied systems like UK NHS don't send letters rejecting coverage.

How would a person know if they have “secure middle class coverage” in advance of serious illness or injury? It’s too late after the fact, and as Suzzer has demonstrated there are so many fees and charges out there it is virtually impossible for a layperson to determine if they have adequate coverage in advance. Not to mention most people who get plans through their employment don’t get to choose their plan, they get to take what their employer chooses which is primarily a cost based decision and is almost never based on providing great catastrophic coverage.

And again as Suzzer demonstrated even if one had proper insurance in advance it does not mean anything as insurance companies will still regularly fight tooth and nail over ever charge in a catastrophic illness or injury case, putting a seriously sick or injured person back in the middle between every provider and the insurer.

Staning for our insurance system is a bad look. It is awful.

It shouldnt be the employers responsibility to cover their healthcare though. Maybe our wage gap wouldnt be quite as large as it is now if instead of paying for insurance, that amount was instead paid as salary.

I never said whether the middle class knows whether they have it.

It is an abomination a significant number of them do NOT have sufficient coverage and DON"T KNOW IT.

Insurance companies don't fight coverage as much as people think. The outlier (rare rejections in common cases or routine rejections in rare therapies) cases are magnified and insurance companies are powerless to fight because people are holding insurance companies to impossible standards (see suzzer's 99.99%) so they just throw out useless platitudes and refuse to give out actual stats.

I actually agree with this sentiment.

That didn't fly because the premiums would be taxed. Even if you give full credit on the other end, a lot of people (namely married couples with two employers giving coverage) would hate this. It's completely irrational but it's how people behave.

To put differently, employer based insurance is another one of those unseen tax breaks that the middle class takes for granted and is really hard to take away.

*As a factual matter, the tax treatment of employer based insurance (premiums paid by employers not taxable to employee) is consistently one of the largest "tax expenditures".

**As I have said in previous posts, I very much would prefer essentially a payroll (Medicare/Medicaid like) tax that is invisible to the employees and use the proceeds to subsidize a Medicare C/ACA+ like system (you can achieve this via mandates/Swiss or public payment to private plans/Germany or a combination thereof).

One last aside, I think we need IRS to tighten its regulations and even definitions of "employee" vs. contractor.

Better yet, Congress needs to get with the times and create a category for, for lack of better term, "temporary employees" where employers are obligated to provide certain benefits even if not the full benefits to traditional salaried workers.

Stop being pedantic



Is M4A a better alternative to what we have now

Yes or no.